Evidence-based pediatric practice requires a thorough understanding of growth in the absence of intervention. Proper treatment planning for craniofacial abnormalities in children and adolescents demands both an accurate assessment of a patient's current facial growth status and a prediction of future growth. Yet, current methods to derive this information are inadequate. Presently, there are no reference charts or practical tools for individualized assessment of these parameters that take into account not only sex and chronological age, but also facial type, cervical vertebral maturity, and past craniofacial measurements. We will identify landmarks on over 13,000 lateral cephalographs from 1,104 individuals, each with at least two observations before and after mid-puberty, for the purpose of building a model to predict the ages of onset, peak velocity, and cessation of pubertal craniofacial growth, and the amount of growth remaining for a given individual. Altogether, we will assess over 30,000 lateral cephalographs from 5,803 individuals, age 0-24 years for the purpose of constructing growth charts for multiple craniofacial traits. These data come from nine growth studies comprising the American Association of Orthodontists Foundation Legacy Collection. Through the analysis of these data, the proposed research will 1) estimate population- and individual-level timing of pubertal growth and adult size for multiple craniofacial traits, 2) provide diagnostic reference charts for craniofacial lengths, angles, and ratios given sex and age, 3) develop prognostic tools to predict remaining growth/change and the timing of the pubertal growth spurt for craniofacial traits, 4) make these valuable resources available to clinicians and researchers via an easy-to-use free web- based application, and 5) apply geometric morphometric techniques to extend current clinical views of quantifying craniofacial growth. The proposed research clearly addresses NIDCR's goal of integrating clinical, and population health approaches to improve diagnostics and optimize outcomes. At the completion of this project, clinical practice will be improved through the availability of easy-to-use web-based tools for diagnosing current status based on craniofacial measurements and predicting future growth based on current measurements, sex, age, facial type, cervical vertebral maturation, and past measurements. Additionally, scientific knowledge will be improved through the dissemination of information regarding population-level reference values for craniofacial lengths, angles, and ratios, and an evaluation of integrated craniofacial growth using geometric morphometric analysis. The overall impact of the proposed research will be a shift in the clinical management of pediatric craniofacial patients toward more evidence-based treatment planning, utilizing references and predictions based on data from the largest North American cephalometric collections.